Emotion Regulation and Organizational Skills in Children With ADHD Symptoms Are Associated With Behavioral Parent Training Adherence.

OBJECTIVE: Behavioral parent training (BPT) is a well-established treatment for ADHD; however, treatment response is variable. Consistency in parent skill use during BPT is known to influence child outcomes post-treatment, while less research has focused on specific child factors that may be impacting parent skill utilization during treatment. The current study examined associations between child organizational skills and emotion dysregulation (ED) with parent treatment adherence during BPT and post-treatment child impairment. METHOD: Parents of 72 children (Mage = 8.31) with ADHD symptoms and impairment participated in BPT which was embedded in a 12-week, multicomponent, school-based intervention for children delivered by school mental health clinicians. Outcomes included parent treatment adherence and child improvements in global impairment post-treatment. RESULTS: Greater pre-treatment child organizational problems were associated with less parent treatment adherence regardless of ADHD symptom severity. Worse pre-treatment child ED was associated with more impairment post-treatment regardless of ADHD symptom severity whereas the effects of child ED on parent treatment adherence were moderated by child ADHD symptom severity. CONCLUSION: The current study suggests that pre-treatment child ED and organizational difficulties impact parent treatment adherence to behavioral interventions targeting ADHD symptoms, potentially in unique ways, and should be considered in future BPT treatment studies.

Improving Adherence to Behavioral Parent Training for ADHD Using Digital Health Tools.

Behavioral Parent Training (BPT) is a well-established treatment for school-age children with ADHD but lack of parent adherence to prescribed parenting strategies limits treatment gains. Digital Health (dHealth) tools can be leveraged to target barriers to parent adherence but existing tools for parenting interventions are limited. New efforts to develop a dHealth tool to target adherence barriers including limited skill competence, EF processes, and low motivation/negative attitudes, are presented and recommendations for future technology-enhanced treatments are provided.

Preschool Executive Function Predicts Childhood Resting-State Functional Connectivity and Attention-Deficit/Hyperactivity Disorder and Depression.

BACKGROUND: Measures of executive function (EF), such as the Behavior Rating Inventory of Executive Function, distinguish children with attention-deficit/hyperactivity disorder (ADHD) from control subjects, but less work has examined relationships to depression or brain network organization. This study examined whether early childhood EF predicted new onset or worsening of ADHD and/or depression and examined how early childhood EF related to functional connectivity of brain networks at school age. METHODS: Participants included 247 children who were enrolled at 3 to 6 years of age from a prospective study of emotion development. The Behavior Rating Inventory of Executive Function Global Executive Composite score was used as the measure of EF in early childhood to predict ADHD and depression diagnoses and symptoms across school age. Resting-state functional magnetic resonance imaging network analyses examined global efficiency in the frontoparietal, cingulo-opercular, salience, and default mode networks and six "hub" seed regions selected to examine between-network connectivity. RESULTS: Early childhood EF predicted new onset and worsening of ADHD and depression symptoms across school age. Greater EF deficits in preschool predicted increased global efficiency in the salience network and altered connectivity with four regions for the dorsal anterior cingulate cortex hub and one region with the insula hub at school age. This altered connectivity was related to increasing ADHD and depression symptoms. CONCLUSIONS: Early executive deficits may be an early common liability for risk of developing ADHD and/or depression and were associated with altered functional connectivity in networks and hub regions relevant to executive processes. Future work could help clarify whether specific EF deficits are implicated in the development of both disorders.